Prevalence, characteristics, and impact of pain during the postpartum period

To identify the prevalence of pain in puerperal women, describe the characteristics of pain and its impacts on the performance of daily life activities, and evaluate satisfaction with received analgesia.

Method:

Cross-sectional study which included women who had given birth. These were evaluated within 72 hours postpartum in a public teaching hospital in São Paulo city. Obstetric and clinical data were evaluated, as well as presence and characteristics of pain and its impact on daily activities.

Results:

A total 128 women participated in this study. The prevalence of pain was 36.7% during the interview and 54.6% in the previous 24 hours. The main pain site was the abdominal region (64.7%) and pain intensity was moderate to 48.9% of women, with intermittent frequency in 58% of the cases. There was a significant association between presence of pain and type of delivery (cesarean; p=0.030). Not being able to provide care to the newborn, requiring going to a different unit, increased pain perception (p=0.038). A significant impact of pain on the capacity of walking, eating, sleeping, taking care of the baby, evacuating, breathing deeply, breastfeeding, and sitting was verified.

Conclusion:

Pain was frequent during the postpartum period and significantly affected the mothers’ activities, indicating a need for improving pain management in puerperium.

DESCRIPTORS:
Pain; Postpartum Period; Obstetric Nursing; Maternal-Child Nursing

Variables	N	%
Primary pain site (n = 88)
Abdominal	57	64.7
Perineal and genital	15	17.0
Dorsal (above the waistline)	6	6.8
Breast	4	4.6
Head	2	2.3
Pelvic	2	2.3
Cervical	1	1.1
UL^* * UL – Upper limbs	1	1.1
Secondary pain site (n =14)
Perineal and genital	5	35.8
Abdominal	3	21.4
Nipples	2	14.3
Dorsal (above the waistline)	2	14.3
Lumbar (below the waistline)	1	7.1
LL^ LL – Lower limbs	1	7.1

Variables	Total sample n (%)	Current pain (%)	p-value	Pain in 24 hours (%)	p-value
Mother’s age (years)			0.571		0.338
<20	16 (12.5)	10.6		10.0
20├25	39 (30.4)	31.9		30.0
25├30	37 (28.9)	23.4		28.6
30├35	18 (14.0)	19.2		14.3
≥ 35	18 (14.0)	14.9		17.1
Pregnancies			0.793		0.298
Primigravida	59 (46)	39.0		55.9
Multigravida	69 (54)	34.8		53.6
Parity			0.927		0.627
Primiparous	52 (40.6)	36.5		57.7
Multiparous	76 (59.4)	37.3		53.3
NB in RI ^ NB in RI- Newborn in Rooming-in unit;			0.209		0.038
No	14 (10.9)	57.1		71.4
Yes	114 (89.0)	34.2		52.6
Type of delivery			0.567		0.030
Cesarean	53 (41.4)	39.6		66.0
Vaginal^* ***** Vaginal - Normal and Forceps;	75 (58.6)	34.7		46.7
Perineal trauma			0.395		0.455
Intact	30 (40.0)	29.0		38.2
RD1^# # RD1 - First degree rupture;	15 (20.0)	26.7		53.3
RD2^## ## RD2- Second degree rupture. /Episiotomy	30 (40.0)	43.3		53.3

	Pain intensity
	n (%)	Mean (SD^# # Standard Deviation; )	Median	p-value^* * T test
Type of delivery				0.220
Cesarean	41 (46.5)	5.8 (2.3)	6.0
Vaginal	47 (53.5)	5.3 (1.9)	5.0
Type of anesthesia				0.499
None	17 (19.4)	5.8 (1.4)	5.5
Subarachnoid	51 (57.9)	5.6 (2.3)	5.0
Local	20 (22.7)	5.0 (1.7)	5.0

Variables	OR^# # Odds Ratio;	CI 95%	P-value^* * Linear Regression Model
Sitting	1.56	1.35 - 1.85	<0.001
Walking	1.48	1.29 - 1.75	<0.001
Eating	1.43	1.14 - 1.90	0.002
Moving on the Bed	1.40	1.23 - 1.63	<0.001
Breathing deeply	1.40	1.22 - 1.63	<0.001
Evacuating	1.39	1.17 - 1.72	<0.001
Breastfeeding the baby	1.33	1.16 - 1.57	<0.001
Caring for the baby	1.29	1.13 - 1.51	<0.001
Sleeping	1.26	1.10 - 1.48	0.001
Brushing teeth	1.26	0.96 - 1.75	0.097
Combing hair	1.14	0.91 - 1.47	0.256

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Marina de Góes Salvetti. Escola de Enfermagem da Universidade de São Paulo, Rua Dr. Enéas de Carvalho Aguiar, 419, Cerqueira CésarCEP 05403-000 - São Paulo, SP, Brazil. mgsalvetti@usp.br